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Home My WebLink AboutPermit Electrical 2013-8-16 SPRINGFIELD 225 Fifth St CITY OF SPRINGFIELD Springfield,OR 97477 110t<0.oxceoI Phone: 541-726-3753 Building / Residential Permit Inspection Phone: 541-726-3769 • Fax: 541-726-3676 PERMIT NO: 811-SPR2013-01830 www.springfield-or.gov permitcenter@sphngfield-or.gov PROJECT STATUS: Issued ISSUED: 08/16/2013 EXPIRES: 02/11/2014 STATUS DATE: 08/16/2013 APPLIED: 08/16/2013 SITE ADDRESS: 1140.1 ST,Springfield,OR 97477 • SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1703264414500 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Panel Change Out OWNER: REEL MICHAEL G Phone Number: ADDRESS: 1140 J ST SPRINGFIELD OR 97477 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone OWNER CCB 000000 08/01/2025 INSPECTIONS REQUIRED Inspections 4210 Service Change 4500 Rough Electrical Rough Electric: Prior to Cover 4999 Final Electrical Final Electric: When all electrical work is complete. By signature, I state and agree,that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State or Oregon pertaining to the work described herein,and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street,that the • permit card is located at the ffdht oft property, and the approved set of plans will remain on the site at all times during c onstruction. }�(� Owner or Contractor Signat‘ Date • ATTENTION: Oregon law requires you to NOTICE: follow rules adopted Those by the rules Oregon set fort THIS PERMIT SHALL EXPIRE IF THE WORK Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001- 1UTHORIZED UNDER THIS PERMIT IS NOT 0090. You may obtain copies of the rules by ';Ib1MENCED OR IS ABANDONED FOR calling the center. number '' nAY PERIOD. r., Springfield Building Permit 8/16/2013 9:06:51AM Page 1 of 1 • SPRINGFIELD CITY OF SPRINGFIELD 't 225 Fifth St ;. TRANSACTION RECEIPT Springfield,OR97477 OREGON 541-726-3753 811-SPR2013-01830 www.springfieldor.goy 1140 J ST permitcenter @spdngfield-ar.gov RECEIPT NO: 2013001777 RECORD NO: 811 SPR2013-01830 DATE:08/16/2013 ON s 'r' `` ` :fi ,�-,';:r-: ri,, -ginACCOUNT"CODE/TRANS CODE±I: ' `. .AMOUNTaDUE Services 200 amps or less 224-00000-426102 1004 89.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 10.68 Technology fee(5%of permit total) 100-00000-425605 2099 4.45 TOTAL DUE: 104.13 P.AYMENTisiT'P-E.. PAY,OR CASHIER.JLARSON COMMENTS =. ,._,,:��AMOUN RAII2 Credit Card REEL MICHAEL G 104.13 218692 TOTAL PAID: 104.13 • • Electrical Permit Application DEPARTMENT USE ONLY - pp SPNINGFIEIG CIT OF SPRINGFIELD, ORE i,isk .a�5rT Elm/ Permitno.:g(I ZGY3 ot63° 225 Fifth Street•Springfield,OR 97477•PH(541)726-3753♦FAX(541)726-3689 ""' / Date: 8// Y,// This permit is issued under OAR 918-309-0000. Permits are nontransferable.Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. LOCAL ;GOVERNMENT;APPROVAL .` -',. FEE`SCHEDULE ; y xz(^,_ 7 l 'Y _ , Cost Total'° Zoning approval verified? ❑Yes ❑ No Numher of thspechons per.item O - Qty` ;:ea. . z cdst` °CATEGORY;�OFzCONSTRUCTION =r' sfiz . „-, Residential,per unit,service included: Residential ❑Government ❑ Commercial 7? .,.. 1,000 sq. ft. or less(4) $147.50 $ . :JO[31,SITE INFO ,MATION-'AND."LOCATION' ;' j ID �- i Each additional 500 sq.ft.or portion $ 27.50 $ Job site address: thereof City: S/ Y State:Dp- I ZIP: (774.7/ Limited energy(2) $ 35.00 $ Reference: Taxlot.: Each manufactured home or modular $ 69.00 $ dwelling service or feeder(2) / r*IT,";uOESCRIPTIO �OFt�WORK` x u 'n-,;. ( (—+'1.4�a(/&V e' 'YQq , Q{— /ANSI-( Services or feeders: installation, alteration,relocation 200 amps or less(2) I $ 89.00 $ „y ,:P.ROPERTY Q_WNER ,;3, : ; = 201 to 400 amps(2) $ 104.50 $ Name. 401 to 600 amps(2) $174.00 $ • Address: II S 601 to 1,000 amps(2) $225.50 $ City: y�pr� State: Q-. ZIP: 9 7¢---77 Over 1,000 amps or volts(2) $516.00 $ Phone:AA $T 1 075"2, Fax: - 14e,- Reconnect only(2) $ 69.00 $ �YQ-e ( 5-5- , if ar CAN Temporary services or feeders: installation, alteration, relocation E-mail: (�' This installation is being made on reside ial or farm property 200 amps or less(2) $ 69.00 $ owned by\me or a member of my . iate family. This 201 to 400 amps(2) $ 96.00 $ property ii not intended for sale, than , lease, or rent. OAR 479.540(13 Md 479 560(1 a, 401 to 600 amps(2) $138.50 $ Signature: I I� Over 600 amps or 1,000 volts,see services or feeders section above ', gi;c::* .,CONTRACTOR IN6TA ION .'Sr=)h-, Branch circuits:new, alteration, extension per panel • Business name: a. Fee for branch circuits with purchase of a service or feeder fee: Address: Each branch circuit $ 6.50 $ City: State: ZIP: b.Fee for branch circuits without purchase of a service or feeder fee: Phone: - - Fax: - - First branch circuit(2) $ 60.50 $ E-mail: . Each additional branch circuit $ 6.50 $ CCB license no.: BCD license no.: Miscellaneous fees:service or feeder not included Signing supervisor's license no.: Each pump or irrigation circle(2) $ 69.00 $ Print name of signing supervisor: Each sign or outline lighting(2) $ 69.00 $ Signature of signing supervisor: • Signal circuit or a limited-energy panel, $•80.00 $ Signature g g P alteration,or extension(2) Each additional inspection:(I) $80.00 $ "r! 4 t e a0PLICANT USEWR O wi°1, :, (A) Enter subtotal of above fees $ (Minimum Permit Fee$80.00) (B)Enter 12%surcharge(.12 x[A]) - $ • (C)Technology Fee(5%of[A]) $ TOTAL fees and surcharges(A through C): $/oty — 440-2584-1(4/01/2013/COM) . . Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325 (2)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. • Please check the appropriate box: • I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or \tv 1 I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. (tUk & 4. Rcez- -rint Name of P: itApplica i AAA( Signature of Permit Applican Date • • cflcrir. %c- Permit#: o F o Address: '=ham NSl7/'S' YfuM2;i,' Issued by: Date: 8.5 9 This Copy for Permit Offices